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Telemed docs no more or less likely to prescribe antibiotics

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Antibiotic prescriptions were as frequent among doctors providing care through a telemedicine appointment as physicians who saw patients face-to-face, a new study found, but the types of antibiotics prescribed via telemedicine were more expensive and could increase antimicrobial resistance.

The study, conducted by the Rand Corp., and published Tuesday in JAMA Internal Medicine, analyzed telemedicine appointments for 1,700 patients who received treatment for respiratory infections between April 2012 and October 2013 by provider Teladoc and compared them with 64,000 patients who were treated at a doctor's office for the same condition.

Researchers found both treatment settings had high rates of using antibiotics for treating acute respiratory infections, which has been estimated to not be clinically necessary in about half of all outpatient antibiotic prescriptions.

It found patients who used Teladoc were prescribed antibiotics at a rate of 58% compared with 55% at a doctor's office, suggesting there was little difference in the quality of care provided across both health settings.

Teladoc physicians, however, were found to prescribe broad-spectrum antibiotics at a rate of 86% compared with 56% at a doctor's office. Those types of antibiotics are used against a wide range of pathogens.

The study's lead author Lori Uscher-Pines, a policy researcher at RAND, said that suggests telemedicine physicians acted more conservatively in their treatment because of the limitations in getting a more accurate diagnosis. Overprescribing of broad-spectrum antibiotics raises concerns that pathogens may develop resistance to those drugs, further limiting treatment options against antimicrobial illness.

The study suggests that telemedicine providers should take precautions to consider quality-improvement initiatives to change physicians behavior when it comes to prescribing antibiotics.

Overall, the study seems to suggest, at least initially, the quality of care provided by telemedicine physicians may be comparable to that found in a doctor's office. Critics of telemedicine raise safety concerns over the possibility of physicians misdiagnosing patients because of their inability to run laboratory tests or engage in a physical examination.

The debate over telemedicine has only intensified in recent years with the rising shortage in physicians. A recent analysis by market research firm RNCOS valued the telemedicine industry at around $14.8 billion in 2014, and was expected to grow at a compound annual growth rate of 18% up to 2020.

Last month, the Texas Medical Board voted in favor of limiting the practice of telemedicine in the state to require physicians to have in-person visits with patients before they are allowed to conduct healthcare appointments through telecommunication technologies, unless the patient is in a medical setting at the time of the initial telemedicine visit.

Few empirical studies have been conducted looking at the issues involving the quality and safety of care provided by telemedicine physicians.

“There has been, unfortunately, mostly anecdotal feedback on the quality of care delivered through telehealth,” said Jason Gorevic, CEO of Teladoc. “This is one of the few empirical sets of data analysis and demonstrates the high quality of care provided by Teladoc.”

Steven Ross Johnson writes for Modern Healthcare, a sister publication of Business Insurance.